title: Secondhand smoke exposure in preterm infants with bronchopulmonary dysplasia.
abstract: OBJECTIVE
  Preterm infants and children with bronchopulmonary dysplasia (BPD) often experience significant respiratory morbidities during the first two years of life. Second hand smoke (SHS) has been demonstrated to lead to respiratory morbidities in the general population. The objectives of this study were to assess the prevalence/impact of SHS on preterm infants and children with BPD.
  
  
  METHODS
  Subjects (n = 352) were recruited from the Johns Hopkins BPD outpatient clinic between January 2008 and August 2012. Second hand smoke exposure and respiratory morbidities were assessed through questionnaires and chart review.
  
  
  RESULTS
  Twenty-eight percent of preterm infants with BPD were exposed to SHS in the home setting, despite having significant lung disease. SHS was associated with multiple measures of socio-economic status, including lower household income (P < 0.001), lower caregiver education level (P = 0.013), and having public versus private insurance (P = 0.002). We found no difference in acute care use or chronic symptoms with SHS exposure. We observed trends that preterm infants who were exposed to SHS were more likely to be prescribed inhaled corticosteroids (P = 0.054) and were weaned off of supplemental oxygen over 2 months later (P = 0.13) than infants not exposed to SHS.
  
  
  CONCLUSIONS
  SHS exposure in preterm infants with BPD is common, even in those receiving supplemental oxygen and respiratory medications. Although there were no associations between respiratory outcomes and self-reported SHS exposure, trends toward increased use of inhaled steroids and a longer duration of supplemental oxygen use were noted. Further work is needed to determine more accurate means of assessing SHS risk in this vulnerable population.
authors.affiliation: Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins Medical Institutions, Baltimore, Maryland.
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Collaco
authors.forename: Angela D
authors.initials: AD
authors.lastname: Aherrera
authors.forename: Timothy
authors.initials: T
authors.lastname: Ryan
authors.forename: Sharon A
authors.initials: SA
authors.lastname: McGrath-Morrow
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use; D001997:Bronchopulmonary Dysplasia / Q000628:therapy; D003131:Combined Modality Therapy; D004781:Environmental Exposure / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D012189:Retrospective Studies; D057566:Self Report; D011795:Surveys and Questionnaires; D014028:Tobacco Smoke Pollution / Q000706:statistics & numerical data*
chemical_list: D000305:Adrenal Cortex Hormones; D000893:Anti-Inflammatory Agents; D014028:Tobacco Smoke Pollution
keywords: bronchopulmonary dysplasia; chronic lung disease; environmental tobacco smoke; prematurity; secondhand smoke